Malignant soft tissue lesions

Question 1

Most important factor for limiting recurrence

Answer 1

margins

Question 2

Soft tissue sarcomas that spread to regional lymph nodes

Answer 2

rhabdomyosarcoma, synovial sarcoma, clear cell sarcoma, epitheloid sarcoma, angiosarcoma

Question 3

Most common sarcoma in lower extremities, young adult, cystic appearing with fluid levels, may have mineralization

Answer 3

Synovial sarcoma, mets to lung, Surgical excision and radiation

Question 4

Translocation for synovial sarcoma

Answer 4

X:18, SYT SSX1 or 2 fusion protein

vimentin, keratin, EMA

Question 5

Aggressive soft tissue lesion, often in retroperitoneum but moth eaten apearance to metaphysis of long bone, histo blunt cigar shaped nuclei with pink cytoplast

Answer 5

Leiomyosarcoma

wide excision and radiation chemo if lung mets

desmin/actin (muscle), +vimentin (sarcoma)

Question 6

old person, chronic venous statis, overlying skin changes

Answer 6

angiosarcoma, tumor from endothelium of blood vessels

surgery and radiation

Question 7

young adult with tumor in hand or forearm, nodular pattern with central necrosis, eosinophilic cytoplasm

Answer 7

epitheliod sarcoma, keratin +, wide resection and radiation

beware of lymph node spread

Question 8

20-40 yo, usually associated with tendons on dorsum of foot, sheets of cells with clear cytoplasma and spindle cells

Answer 8

clear cell sarcoma, amputation and chemo

Question 9

clear cell sarcoma translocation and staining

Answer 9

S-100, HMB-45

t(12;22) EWS AFT1, neuroectodermal

Question 10

most common soft tissue sarcoma in children

Answer 10

rhabdomyosarcoma

Question 11

Translocation for rhabdomyosarcoma

Answer 11

t(2:13) Pax3-FKHR

Question 12

Treatment for rhabdomyosarcoma

Answer 12

chemo, resection, radiation

Lymph node spread common, must do bone marrow aspiration

Question 13

Stains positive in rhabdomyosarcoma

Answer 13

vitemin, desmin/actin, myosin(MyoD1)

Question 14

most common soft tissue sarcoma, middle aged, deep lesions in thigh or retroperitoneum

Answer 14

Liposarcoma

Question 15

chromosomal translocation of myxoid liposarcoma

Answer 15

t(12;16) CHOP,TLS

MDM2

always order CT chest/ab/pelvis in myxoid

Question 16

Types of liposarcoma

Answer 16

well-differentieated, myxoid, round cell, pleomorphic, undiff

Question 17

treatment for liposarcoma

Answer 17

resection and radiation

Question 18

Important prognostic factor in melanoma

Answer 18

depth

Question 19

Treatment of melanoma

Answer 19

<1mm local resection

> 1mm local resection with 1-2cm margin, sentinel node bx

Question 20

Tumor of brown fat

Answer 20

hibernoma

Question 21

Treatment of atypical liposarcoma

Answer 21

resection

Question 22

Patient with history of abdominal wall cancer, possible historyof FAP or Gardner syndrome, aggressive bubbly lesion if in bone

Answer 22

Desmoid tumor (fibromatosis), desmoplastic fibroma

usually around shoulder

dense spindlecellsin rows with elongated nuclei

Question 23

Treatment of desmoid tumor

Answer 23

NSAID, chemo, resection

tamoxifen if estrogen receptor positive

increased beta catenin (trisomy 8 or 20)

Question 24

Recurrent atraumatic hemoarthrosis, possible erosive changes on xrays, blooms on MRI

Answer 24

PVNS (tenosynovial giant cell)

hemosiderin in giant cells

focal nodular (simpe excision), extensive synovectomy plus radiation otherwise

Over expression of CSF-1 (pexidantinib)

Question 25

Middle aged patient with painful mass on finger tip, bluish color, nail ridging, sensitive

Answer 25

Glomus tumor (pain, tenderness, cold intolerance) - perivascular temp regulating structure

small round blue cells on histo

Marginal excision

Question 26

Middle aged patient with metaplastic changes in synovial tissue and chondroid loose bodies in the joint

Answer 26

Synovial chondromatosis (osteochondromatosis if mineralized on xray)

marbles in joint, histo shows hyaline cartilage

remove loose bodes and synovectomy